Saturday, August 11, 2007

Are you guilty of medical thought crime?

You may be if you hold to certain political views. I’m not talking about extreme positions and ideas that most decent human beings, regardless of political affiliation, know are morally outrageous. But our professional culture is becoming increasingly Orwellian as an ideologically correct medical thought police, expressing itself through journals, the web and other media, increasingly defines what is acceptable in the realm of speech and ideas.

Though I’ve observed the trend for a long time several recent examples have emboldened me to challenge the prevailing orthodoxy. Recently I linked to this Kevin post about the Lucidicus Project and suggested that medical students check it out as an alternative to the popular dogma concerning single payer health care. This was met with indignant and morally superior comments from two anonymous readers. One, apparently in academic medicine, implied that conservative thinking equals greed:

This philosophy starts at the top with our president who feels tax cuts for his friends the uber rich are clearly more important than health care for children.The best definition I've heard for compassionate conservatism is I feel your pain,I just don't plan to to a damn thing about it. So be greedy, and selfish, but don't complain when some calls you that.

The other commenter was outraged at the mere suggestion that medical students read material supporting capitalism:

So RW the champion of critical thought & skepticism is championing a site that suggests medical students need to read ayn rand and propaganda material about how capitalism is good for medicine? Give me a break.

Of course I wasn’t championing anything. The commenter was clearly rankled. Does he/she believe that medical students should be banned from reading politically conservative literature?

More examples:

Not long ago we were told that if we didn’t feel guilt and shame about global warming we need psychiatric help to increase our anxiety.

And there’s this JAMA commentary that tells us what we may and may not say about health care in the U.S.

More recently Retired Doc dropped a bomb with this post about a JAMA piece which appears to redefine medical ethics in terms of a sociopolitical agenda which favors increased government intrusion into our profession and implies that failure to support such an agenda is a betrayal of ethical principles to which physicians are honor bound.

If you want to promote your political agenda I’m willing to be convinced with evidence or logic. Engage me in a collegial discussion, but don’t try to shame me or impugn my character if I happen to disagree.

3 comments:

DR. RW, the level of political discourse has deteriorated to the point where dogma takes precedence over logic.

However in this case, I would question the logic. There is a lack of critical thinking in your suggestion that a medical thought police is in action.

First, let me say that Ayn Rand's brand of social darwinism is hardly a good starting point for analyzing social programs. Nor is Ayn Rand's philosophy entirely consistent with that part of medicine that is considered a "calling". I know it is hard to imagine, but there was a time when a student going into medicine for "the good of humanity" was not a laughable notion.

Conservative thinking (in this case, I think we mean capitalist philosophy) emphasizes an individual determination of "good." The market reflects the sum total of those decisions. Nowhere is to be found the notion of selfishness, except to question that maybe it's not all bad if selfishness means you purchase what makes you happy.

Marie-Antoinette was selfish and insensitive. So are so-called "conservatives" in the current political discourse. The rule of law will not protect the wealthy if desperation leads to mob rule. Enlightened self-interest (also a conservative trend) would suggest the limits to any philosophical approach to social programs based on Ayn Rand.

The Lucidicus project makes no distinction between universal health care and a single payer. On the face of it, Lucidicus is so poorly thought out, it deserves torpedoes, just on the basis of intellectual integrity.

Your personal objections to the objections of others is nothing more than a circular argument. I think I understand what you are trying to say about what is implied in your multiple examples, but, please: your approach is close to name-calling. Orwellian thought police may be a little extreme for any open and honest intellectual discussion.

I would beseech you to work the issues sir, lest the whole discussion on health care reform, amongst other things, continues to decline further along an "us and them" spectrum.